Ketamine for depression: a potential role in requests for Medical Aid in Dying?
International clinical psychopharmacology – September 01, 2023
Source: PubMed
Summary
Access to Medical Aid in Dying (MAiD) for psychiatric conditions is rising, with mood disorders being the most common reason. A notable case involved a Canadian patient seeking MAiD due to severe treatment-resistant depression. Remarkably, after receiving intravenous ketamine infusions, she experienced significant improvement, challenging the notion of irremediability in such cases. This suggests that exploring alternative treatments like ketamine could be crucial before considering MAiD, highlighting the need for careful evaluation of psychiatric requests for assisted dying.
Abstract
Medical Aid in Dying (MAiD) is the act of a healthcare provider ending a patient's life, at their request, due to unbearable suffering from a grievous and incurable disease. Access to MAiD has expanded in the last decade and, more recently, it has been made available for psychiatric illnesses in a few countries. Recent studies have found that such psychiatric requests are rapidly increasing and primarily involve mood disorders as the primary condition. Nevertheless, MAiD for psychiatric disorders is associated with significant controversy and debate, especially regarding the definition and determination of irremediability - that a given patient lacks any reasonable prospect for recovery. In this article, we report the case of a Canadian patient who was actively requesting Medical Assistance in Dying for severe and prolonged treatment-resistant depression until she experienced remarkable benefits from a course of intravenous ketamine infusions. To our knowledge, this is the first report of ketamine or any other intervention yielding remission in a patient who would have otherwise likely been eligible for MAiD for depression. We discuss implications for the evaluation of similar requests and, more specifically, why a trial of ketamine warrants consideration.